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Redefining the Supraclavicular Anatomy of the Brachial Plexus
Sophia Leung, MD1; Dan Zlotolow, MD2; Scott Kozin, MD2; Joshua Abzug, MD1; (1)University of Maryland Medical Center, (2)Shriners Hospital for Children Philadelphia
University of Maryland Medical Center, Baltimore, MD, USA


The brachial plexus is encountered surgically in infants when addressing birth palsies, most commonly in the area of the upper trunk. Additionally, adult traumatic injuries may require exploration with repair or nerve transfer. Thorough understanding of the course of branches, such as the suprascapular nerve, is vital to performing nerve transfer surgery or neuroma excision and grafting. Traditional drawings of the plexus demonstrate that the suprascapular nerve is a branch off the midportion of the upper trunk, with the lateral division of the upper trunk being the anterior division, however, we have not found these descriptions to be accurate.

Materials and Methods

Brachial plexus dissections were performed on eight age-matched adult cadavers bilaterally, for a total of sixteen specimens. Once the upper trunk and surrounding structures were identified, the following measurements were taken three times with the use of a digital caliper: length of the upper trunk and distance of the takeoff of the suprascapular nerve from the divisions. Mean values were calculated for all measurements. Native positions of the divisions and suprascapular nerve form lateral to medial were recorded.


In all sixteen specimens, a trifurcation was found at the level of the upper trunk, with the structures from lateral to medial being the suprascapular nerve, the posterior division, and the anterior division. The mean distance of the takeoff of the suprascapular nerve was 3.57 mm proximal to the anterior and posterior divisions, however in some instances the nerve was found to take off from the posterior division proper. The mean length of the upper trunk was 28.88 mm.


These findings question the standard illustrations and depictions of the brachial plexus anatomy. In fact, the suprascapular nerve, posterior division, and anterior division should be depicted as a trifurcation in this order from lateral to medial. This understanding will facilitate dissection and grafting across the upper trunk as well as aid in nerve transfer surgeries.

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